Increasing HIV treatment access, uptake and use among men who have sex with men in urban Indonesia: evidence from a qualitative study in three cities

Abstract

Men who have sex with men make up one of four key populations identified as critical to a successful HIV response in Indonesia. Despite international policies supporting HIV treatment in low- and middle-income countries, Indonesia is one of the few countries experiencing low coverage of HIV treatment and little decrease in HIV incidence. There is poor retention in care and low viral suppression rates among key populations such as men who have sex with men. The national government has committed to increasing treatment access and uptake for people with HIV but little is known about how these men themselves view, use and experience these medications. Drawing on qualitative data collected in 2015–16 from 24 HIV-positive men who have sex with men living in three Indonesian cities, we observed multiple intersecting social and contextual factors that can influence effective HIV treatment use. Although shared stories of strong side effects and fear of unwanted disclosure inhibited treatment uptake, social support from ‘buddies’ helped to navigate healthcare systems and sharing medication among peers enabled adherence. In order to improve treatment uptake and adherence among Indonesian men who have sex with men living with HIV, these divergent effects of the social meanings and practices associated with HIV treatments in Indonesia must be better acknowledged. A more comprehensive understanding of social and community practices within key populations can strengthen national efforts to improve treatment access and increase adherence. Ongoing decentralization of healthcare in Indonesia, and differentiated care models that enable initiation of treatment in community settings and involve non-medical, community-based organizations in the provision of treatment services have the potential to address the needs of individuals who fall into a key population category such as men who have sex with men.

Corrigendum to: A strengths-based analysis of social influences that enhance HIV testing among female sex workers in urban Indonesia

“…Consistent with global HIV guidelines that emphasise community involvement in national HIV responses, 42,43 our findings show that relations and practices involving female sex workers, community outreach workers, health workers and bosses enabled HIV testing among female sex workers in three urban settings in Indonesia. Our findings complement recent qualitative research around engagement with HIV care for testing and/or treatment among other key populations in Indonesia [35][36][37][38] which also illustrate how community mechanisms enhance engagement in HIV care. As such, our findings provide insight into the improvement of, and community participation and leadership in, HIV responses in Indonesia and other LMICs in the region.…”

“…This qualitative study was part of a larger implementation research project designed to evaluate strategies to improve the HIV care cascade among female sex workers, people who inject drugs, transgender women and men who have sex with men in Indonesia. [35][36][37][38][39] Women were eligible to participate in the study if they were currently engaged in sex work, aged 16 years and able to provide informed consent. Participants were sampled purposively 40 to ensure diverse experiences with engagement in HIV testing, treatment and care services along the HIV care cascade.…”

Understanding the challenges faced in community-based outreach programs aimed at men who have sex with men in urban Indonesia

“…Our findings build on other research findings that document factors influencing access to HIV care among MSM, attending to the role that OWs play in Indonesia's HIV response. 10,15 It suggests the possibility not only for partnerships between healthcare workers and the community, but also for a crossover in personnel. It suggests that the MSM community is capable of participating in the Indonesian HIV response in more diverse capacities than only in the roles commonly associated with OWs.…”

“…In Indonesia, one qualitative study in three Indonesian cities found that social support from community-based OWs played an important role in helping MSM to navigate healthcare systems. 15 Another study found that, from the point of view of transgender women and MSM subjects of HIV prevention programs, OWs acted as a motivation for accessing HIV testing, care and treatment, along with the provision of easy-to-understand HIV information. The same study also described several possible limitations; including the perception that OWs could improve the appearance and delivery of HIV-related information so that it would be better tailored for specific groups within the community.…”

Pendekatan Multi-disiplin; Dari Sebuah Diskursus ke Arah Profesionalisme Riset dan Pendidikan Kesehatan Masyarakat

“…Studi HATI menunjukkan integrasi layanan tes dan pengobatan dalam satu atap meningkatkan peluang untuk memulai pengobatan secara lebih cepat dan keberhasilan pengobatan lebih baik (Januraga et al, 2018). Sebelumnya, penelitian kualitatif yang dilakukan oleh para peneliti sosial dan antropologi sebagai bagian awal dari HATI melaporkan hambatan akses ke pelayanan kesehatan meliputi aspek sosial dan kontekstual seperti persepsi terhadap sehat dan pengobatan, aspek kerahasiaan, dukungan dan pertimbangan stigma (Mitchell et al, 2019;Lazuardi et al, 2020). Di sinilah sekali lagi pendekatan multi-disiplin berhasil dimanfaatkan untuk mengidentifikasi masalah program kesehatan termasuk memformulasi intervensi yang sesuai untuk mengatasi hambatan sosial dan kontekstual yang ada untuk akses layanan HIV-AIDS.…”